SEARCH · PubMed Health

Results for “CHOLECYSTECTOMY”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 415 records · Page 23Linked to original sources

PubMedDate not supplied

Changes of CPK and CPK-MB levels after open and laparoscopic cholecystectomy.

According to the World Health Organization, an increased ratio (more than 6%) of CPK-MB to total CPK may indicate the diagnosis of an acute infarction. But false elevation of CPK and CPK-MB levels after noncardiac operation, because of soft tissue damage, may confuse the clinicians in detecting myocardial infarction in early postoperative period. In order to determine the usefulness of CPK-MB to total CPK ratio in detecting myocardial infarction after open and laparoscopic cholecystectomy, we measured the serum levels of these markers in 135 patients, immediately after the operation and for the next five days. Patients were divided into four groups according to type of surgical procedure, as follows: Group I: a right oblique subcostal (Kocher's) incision was performed in 29 patients, Group II: a right paramedian transrectal incision was performed in 52 patients, Group III: a vertical high midline incision was performed in 17 patients, Group IV: laparoscopic cholecystectomy was performed in 37 patients. Although we found increased levels of CPK and CPK-MB after all the types of cholecystectomy, but in any case the CPK-MB exceeded more than 6% of total serum CPK. Furthermore we noticed that the patients who underwent open cholecystectomy with right oblique subcostal incision had the most elevated CPK and CPK-MB levels comparing to the other types of cholecystectomy. In conclusion, tissue damage after elective cholecystectomy is minimal and CPK-MB to total CPK ratio is a secure marker in detection of myocardial infarction during early post-operation period, after cholecystectomy.

Adolescent↗

PubMedDate not supplied

[Cause of pain in patients surgically treated for cholelithiasis and post-cholecystectomy syndrome].

Cholecystectomy does not mean an end of all problems in every patients because some of operated patients continue to complain. Usually such complaints are called post-cholecystectomy syndrome. Eighty three patients, who underwent cholecystectomy were examined. Postoperative complications were excluded, and post-cholecystectomy syndrome diagnosed because of persisting complaints. Definite additional disease associated with gastric and duodenal disorders was found in about 50% of all examined patients (56 cases). In further 23 patients repeated diagnostic tests enabled to establish probable reason of the disorders. The studies have shown that disorders noted after cholecystectomy and termed as post-cholecystectomy syndrome are as much as in 63% of patients not related to previous surgery. Therefore, this widely used name should not be applied to all complaints following cholecystectomy, and attempts of finding other causes of the ailments including other organs diseases should be undertaken.

Adult↗

PubMed1987

Association of cholecystectomy with abdominal cancers.

Five hundred and eighty-five randomly selected patients with abdominal cancer were examined with respect to previous cholecystectomy in the following groups: upper gastrointestinal (gastric or esophageal) cancer; biliary or pancreatic cancer; colorectal cancer, and urologic (renal, pelvic or ureteral) cancer. The frequency of cholecystectomy in each of these cancer groups was compared with that of cholecystectomy in the general population of the region from which the cancer patients came; the latter frequency was estimated in a previous epidemiological autopsy study. In all the gastrointestinal cancer groups studied there was a statistically significantly higher frequency of cholecystectomy than in the general population. In addition, the time interval from cholecystectomy to diagnosis of the cancer was determined. A trimodal distribution of this time interval was observed. The apex of the first peak was about 5, the second about 15, and the third about 23 years after cholecystectomy. Within the first period there was a statistically significant accumulation of biliary, and especially pancreatic, cancer (p = 0.007), and within the second and third periods an accumulation, though not statistically significant, of colorectal cancers (p = 0.07). Of the patients operated on ten years or less before the diagnosis of cancer, 96% were operated on for organic gallbladder disease. It seems that symptoms of upper gastrointestinal cancer, and especially of biliary or pancreatic cancer, may be misinterpreted as symptoms of cholepathy, and this may occur even when organic gallbladder disease is present. Furthermore, cholecystectomy might be a predisposing factor for the development of colorectal cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Neoplasms↗

PubMed1987

Cholecystectomy alters the hormonal response of the sphincter of Oddi.

We have previously described a cholecysto-sphincter of Oddi reflex whereby sphincter of Oddi (SO) motility is mediated in part by the degree of gallbladder distension. Therefore, we tested the hypothesis that cholecystectomy alters the response of the SO to endogenous and exogenous hormonal stimulation. Eight months after sham laparotomy (n = 8) or cholecystectomy (n = 10), prairie dogs were anesthetized with alpha-chloralose. The common bile duct was cannulated distally with a side-hole, pressure-monitored catheter perfused with degassed water at 0.15 ml/min. The duodenum was cannulated distal to the SO to allow perfusion of the proximal 30 cm of intestine with 20 mmol/L sodium oleate at 0.4 ml/min. In animals undergoing sham laparotomy the gallbladder was cannulated, aspirated, and kept empty throughout the experiment. SO phasic wave frequency (F), amplitude (A), and baseline pressure were measured for 60 minutes before and during intraduodenal (ID) perfusion of sodium oleate and then for 60 minutes before and 30 minutes during intravenous (IV) infusion of cholecystokinin-octapeptide (CCK-OP) at 10 ng/kg/min. A SO motility index (MI) (MI = F X A) was calculated for each 10-minute period. Common duct diameter and resting SO motility were unaltered 8 months after cholecystectomy. In animals that had sham laparotomy ID infusion of sodium oleate reduced SO MI by 46% (p = 0.06) and 75% (p less than 0.05) at 30 and 60 minutes, respectively, whereas in animals that had cholecystectomy the reduction in SO MI was only 6% and 25% (p less than 0.05) during the same periods. In animals that had sham laparotomy IV CCK-OP increased the SO MI by 175% (p less than 0.05), but in the animals that had cholecystectomy IV CCK-OP increased SO MI by only 60% (no significance). These findings indicate that after cholecystectomy resting SO motility is unaltered, but the response to ID sodium oleate and to IV cholecystokinin is blunted. We suggest that cholecystectomy alters neural pathways that mediate the normal response of the SO to endogenous and exogenous hormonal stimulation.

Ampulla of Vater↗

PubMed1987

Should cholecystectomy be done en passant for asymptomatic cholelithiasis?

The management of asymptomatic gallstones discovered during abdominal surgery is controversial. Should cholecystectomy be performed en passant? The authors report a 4-year survey of 109 patients with asymptomatic cholelithiasis who underwent surgery for other abdominal conditions: colorectal (31), gastric (24), vascular (20), gynecologic (21) and miscellaneous (13). Cholelithiasis was established preoperatively by ultrasonography in 52 of 55 examinations (95%). In the other 54, the gallstones were discovered at operation. Cholecystectomy was performed in 78 patients and in 31 the gallbladder was left in place. In the former group, 11 (14%) had complications, 2 being attributable to the cholecystectomy. Intraoperative cholangiograms were obtained in 43 and led to common-bile-duct explorations in 8. Common-bile-duct stones were found in seven. In the non-cholecystectomized group, three died postoperatively and three were lost to follow-up. Twelve of the remaining 25 are still asymptomatic and 13 have had symptoms: 7 underwent cholecystectomy (4 for acute cholecystitis) between 2 weeks and 11 months after the initial laparotomy. Because of the low morbidity and the relatively high number of cholecystectomies that were subsequently necessary, the authors recommend cholecystectomy en passant unless there is a specific contraindication. They also recommend ultrasonography before major gastrointestinal or vascular surgery in order to plan for cholecystectomy.

Adult↗

PubMed1986

Combined effects of cholecystectomy and lithocholic acid on pancreatic carcinogenesis of N-nitrosobis(2-hydroxypropyl)amine in Syrian golden hamsters.

The effects of cholecystectomy and/or lithocholic acid (LCA) on the composition of biliary bile acid and on pancreatic carcinogenesis by N-nitrosobis(2-hydroxypropyl)amine (BHP) were examined in male Syrian golden hamsters. Cholecystectomy was performed 1 wk before BHP initiation. BHP (250 mg/kg of body weight) was injected s.c. once a wk for 5 wk. A diet containing 0.5% LCA was begun 1 wk after the final BHP injection. All hamsters were sacrificed 36 wk after cholecystectomy, and the pancreas was examined histologically. Only the LCA treatment but no other treatment influenced the bile acid composition, i.e., the increase in LCA and decrease in cholic acid. The incidence of pancreatic carcinoma was 23 of 30 (76.7%) in hamsters receiving cholecystectomy plus BHP followed by LCA diet. The tumor incidence was five of 18 (27.8%) with BHP followed by basal diet, ten of 18 (55.6%) with cholecystectomy plus BHP followed by basal diet, and six of 18 (33.3%) with BHP followed by LCA diet, respectively. The total number of pancreatic carcinomas in hamsters receiving cholecystectomy and BHP followed by LCA diet also increased significantly. These results indicate that combined treatments of cholecystectomy and dietary LCA enhanced BHP-inducing pancreatic carcinogenesis in hamsters.

Adenocarcinoma↗

PubMed1980

Drainage after cholecystectomy.

Sixty-one patients undergoing simple cholecystectomy and 12 undergoing cholecystectomy and exploration of the common bile duct were studied. The volumes produced from the abdominal drains were measured and the postoperative course observed and compared in all cases. The mean total drainage after simple cholecystectomy was 135 ml in 5 days and after cholecystectomy and exploration of the common bile duct 94 ml in 5 days. With such low volumes drained the majority of patients undergoing simple elective cholecystectomy do not need to be drained. In the small number of patients studied our results would also appear to indicate that a policy of non-drainage may be safe after cholecystectomy with exploration of the common bile duct or after cholecystectomy combined with other operative procedures--for example, vagotomy and pyloroplasty. If the surgeon decides to use a drain it would seem that the RediVac system is as efficient as other systems commonly used and is associated with less pain and fewer complications.

Adult↗

PubMed1994

Laparoscopic cholecystectomy in the pregnant patient.

Laparoscopic cholecystectomy has rapidly replaced open cholecystectomy as the preferred surgical treatment of symptomatic cholelithiasis. Although the indications are similar for both procedures, some surgeons believe that pregnancy is a contraindication for the laparoscopic approach. Several recent reports in the literature have shown that laparoscopic cholecystectomy can be performed safely in the pregnant patient. A review of all patients who underwent laparoscopic cholecystectomy from January 1991 to January 1993 at Scott Air Force Base (AFB) and Edwards AFB was performed. Of 248 patients reviewed, four procedures were performed in the gravid patient. All patients were operated on during the second trimester of pregnancy. Laparoscopic cholecystectomy was successful in all four. Cholangiogram was performed in two patients. No postoperative morbidity was encountered (maternal or fetal). Twenty-one cases of laparoscopic cholecystectomy in the pregnant patient, with no fetal or maternal morbidity or mortality, have been reported in the literature to date. We conclude that in selected cases, laparoscopic cholecystectomy can be performed safely during pregnancy.

Adult↗

PubMed1994

Diagnosis and management of bile leaks following laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is now the standard of care for the elective management of gallstone disease. Recent studies have shown the morbidity of laparoscopic cholecystectomy to be similar to that of open cholecystectomy. Postoperative bile leaks have been recognized to be a troublesome problem following laparoscopic cholecystectomy. We present a retrospective review of 854 patients undergoing laparoscopic cholecystectomy at a single institution. Records were reviewed of all patients identified as having postoperative bile leaks. Between January 1990 and April 1991, we have cared for, or been referred, 15 patients with postlaparoscopic cholecystectomy bile leaks (9/854, 1.1% index patients and 6 referred). The location of bile leakage was determined to be the common bile duct (CBD) in two, cystic duct in five, and small accessory ducts located close to the gallbladder bed in the remaining eight. Most patients presented in the first week following laparoscopic cholecystectomy (mean 4.3 +/- 0.7 days, range 2-10) with worsening abdominal pain (13/13, 100%), nausea, and low-grade fever (mean 99.6 +/- 0.3 degrees F, range 96.8-102.2). Eleven of fifteen (66.7%) patients underwent technectium-99m imidodiacetic acid scanning (Tc-99m IDA) to determine the presence of a possible bile leak. All eleven scans were positive, indicating the presence of a bile leak. Thirteen patients underwent endoscopic cholangiography confirming the presence of biliary leakage (the remaining two patients underwent prompt laparotomy). Five patients were taken to the operating room for management of their leaks (two with common bile duct injuries, two cystic duct leaks, one accessory duct leak).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

The course of biliary and gastrointestinal symptoms after treatment of uncomplicated symptomatic gallstones: results of a randomized study comparing extracorporeal shock wave lithotripsy with conventional cholecystectomy.

OBJECTIVES: We performed a randomized study that compared extracorporeal shock wave lithotripsy (ESWL) with conventional cholecystectomy for uncomplicated symptomatic gallstones. The primary outcome of the study was the influence of therapy on biliary colic and gastrointestinal symptoms. METHODS: In the period October 1989-March 1992, 26 patients were randomized for cholecystectomy and 23 for ESWL. Pain diaries and symptom questionnaires were taken before, and 3, 6, 12, 18, and 24 months after therapy. ESWL patients regularly underwent ultrasound examination for determining stone clearance. Median follow-up was 18 months (12-24). RESULTS: Biliary colic was cured in 90.9% and 45.4% of the patients within 3 months after cholecystectomy or ESWL, respectively (p < 0.01). Stomach swelling, fatty food upset, and nausea responded to cholecystectomy after 6, 12, and 18 months, respectively. Nausea responded to ESWL after 6 months. Vomiting, pyrosis, ructus, diarrhea and constipation did not respond to gallstone therapy. When the two treatment arms were compared, only fatty food upset responded significantly better to cholecystectomy than to ESWL at 18 months (p < 0.05). With regard to the other gastrointestinal symptoms, no significant differences could be detected. CONCLUSIONS: We conclude that cholecystectomy is superior to ESWL in improving biliary colic and fatty food upset. Furthermore, because ESWL is not able to clear all stones and harbors the possibility of stone recurrence, cholecystectomy remains the preferred treatment modality in healthy patients with uncomplicated symptomatic gallstones.

Adult↗

PubMed1994

[Acute cholecystitis: indication for emergency laparoscopic cholecystectomy?].

Between 1989 and 1992, 43 patients underwent laparoscopic cholecystectomy for acute cholecystitis. Conversion to open cholecystectomy was necessary in one case (2.3%). Morbidity was 14%, i.e. 7% local complications and 7% systemic complications. No lesions of the CBD occurred and no reoperations or reinterventions were required. Mortality was 0%. The main determining factor for the technical difficulty of laparoscopic cholecystectomy was the lapse of time between onset of symptoms and operation. We show the duration of laparoscopic cholecystectomy during the first 6 days of acute cholecystitis (mean 104 min) is statistically different in the following groups of patients (7-14 days p = 0.0049; 15-21 days p = 0.0037; Mann-Whitney-U-test). We therefore conclude that laparoscopic cholecystectomy is a safe method in acute cholecystitis and that the ideal time of operation is as soon as possible within the first 6 days after onset of illness. Performance of laparoscopic cholecystectomy should not be delayed during this period of acute cholecystitis. If the procedure is carried out by well trained laparoscopic surgeons the risks and complications are equal to those of open cholecystectomy.

Acute Disease↗

PubMed1994

Postmenopausal hormone use and cholecystectomy in a large prospective study.

OBJECTIVE: To examine the association between postmenopausal hormone use and cholecystectomy. METHODS: A prospective cohort study was performed, with follow-up every 2 years. Participants were 54,845 postmenopausal United States nurses, who reported both hormone use and cholecystectomy on mailed questionnaires. RESULTS: Cholecystectomy was reported by 1750 women during 8 years of follow-up. After adjusting for confounding factors, women currently using postmenopausal hormones were at an increased risk of cholecystectomy (relative risk [RR] 2.1, 95% confidence interval [CI] 1.9-2.4) compared to never-users. For current users, the risk of cholecystectomy increased with increasing duration of hormone use (RR 2.6, 95% CI 2.2-3.1 for 10 years or more) and higher doses of estrogen (RR 2.4, 95% CI 2.0-2.9 for users of 1.25 mg or more). Although the risk for past hormone users decreased substantially in women who had discontinued use 1-2.9 years ago (RR 1.6, 95% CI 1.2-2.0), a small risk persisted for women who had stopped taking hormones 5 or more years previously (RR 1.3, 95% CI 1.1-1.6). However, after controlling for time since last use, duration of past use had little or no effect on the risk of cholecystectomy (RR 1.4 and RR 1.7 for past users of less than 2 years and 10 or more years' duration, respectively). CONCLUSION: Women using postmenopausal hormones are at an increased risk of cholecystectomy. Women and their physicians should consider the spectrum of risks and benefits when deciding whether to take hormones.

Cholecystectomy↗

PubMed1994

[The effect of cholecystectomy on cellular proliferation of colonic mucosa in mice].

The relationship between cholecystectomy and colonic cancer has been suggested. The effect of cholecystectomy on cell proliferation of colonic mucosa in mice was studied immunohistochemically using bromodeoxyuridine (BrdU) and anti-BrdU monoclonal antibody after sham operation and cholecystectomy. In addition, the effect of carcinogen 1,2-dimethylhydrazine (DMH), on cellular proliferation of colonic mucosa was following. The results were obtained, (1) Cellular proliferation of colonic mucosa was increased after cholecystectomy. It was suggested that cholecystectomy influenced to the cellular proliferation of colonic mucosa in the study without carcinogen. (2) In the study using DMH, cell proliferation of colonic mucosa was increased after cholecystectomy. (3) At the time for the increased effect of DMH, cholecystectomy group tended to induce earlier proliferative effect than sham operation group.

Animals↗

PubMed1993

Appendectomy incidental to cholecystectomy among elderly Medicare beneficiaries.

To assess the risks of adverse outcomes after appendectomy incidental to cholecystectomy among elderly Medicare beneficiaries, 8,936 persons undergoing cholecystectomy with incidental appendectomy and 44,461 persons undergoing cholecystectomy without incidental appendectomy were studied. Controlling for age, race, gender and co-morbidity status, the risk for wound infection in persons with incidental appendectomy was 83 percent higher than in persons without incidental appendectomy (95 percent confidence interval, 1.53 to 2.18). The risks for having other adverse outcomes, including other infections, extensive intrahospital complications and mortality rate at 30 days, were also higher for the former group, although these differences were not statistically significant. In addition, the demographic characteristics and health status of persons undergoing cholecystectomy with incidental appendectomy with persons undergoing cholecystectomy only were compared. Males, persons of younger ages, of white race or with no co-morbid conditions, were significantly more likely to undergo cholecystectomy with incidental appendectomy. Variables to control for differences in the demographic characteristics and health status between persons receiving and not receiving incidental appendectomy were included in the regression models for adverse outcomes. However, these models may not completely control for differences between the two groups. As a result, the actual relationship between incidental appendectomy and adverse outcomes may be underestimated. The preventive effect of incidental appendectomy on morbidity and mortality rates from future instances of appendicitis was assessed by determining the remaining lifetime risk for acute appendicitis. For persons 65 to 69 years of age, 115 incidental appendectomies would be required to prevent one future instance of appendicitis and 4,472 incidental appendectomies would be needed to prevent a single future death from acute appendicitis. Because incidental appendectomy increases the risk for wound infection among persons undergoing cholecystectomy and because the lifetime risk for acute appendicitis is relatively low for persons of this age group, surgeons should carefully consider the risks and benefits of incidental appendectomy in the elderly.

Acute Disease↗

PubMed1996

Monitoring the introduction of laparoscopic cholecystectomy in a district general hospital.

There has been recent concern regarding the widespread introduction of laparoscopic procedures without adequate training. We report a 2 year prospective series of 229 consecutive open and laparoscopic cholecystectomies, following the introduction of laparoscopic surgery at a district general hospital. All laparoscopic cholecystectomies were performed by surgeons without formal training in this procedure. The proportion of laparoscopic cholecystectomies rose from 27% in 1992 to 62% in 1993, with a conversion rate of 14%. An overall complication rate of 23% was recorded, 29% for open cholecystectomy and 16% for laparoscopic cholecystectomy. Procedure specific complication rates were 6% and 3% respectively. No major bile duct injuries occurred and the 30-day mortality was 0.9%. We conclude that laparoscopic cholecystectomy has been introduced as a safe procedure in this hospital, as compared to open cholecystectomy. It is recommended that new techniques should be introduced carefully and monitored by means of prospective audit.

Cholecystectomy, Laparoscopic↗

PubMedDate not supplied

Twenty to thirty year follow-up after cholecystectomy.

BACKGROUND/AIMS: We studied retrospectively the need for re-examinations and re-operations, the development of alimentary tract cancer, and the occurrence of abdominal symptoms 20-30 years after elective cholecystectomy. MATERIAL AND METHODS: Between 1963 and 1973 296 patients (73 males and 223 females) were treated by cholecystectomy. The indication was biliary colics plus stones in gallbladder. Patients with biliary-enterostomy, sphincteroplasty or synchronous extrabiliary operations were excluded. Retained bile duct stones were excluded by cholangiography. Medical records of all patients, death certificates of the patients who had died during the follow-up (n = 74), and the autopsy findings of autopsied patients (n = 29) were reviewed. The living 220 patients were interviewed by a structured questionnaire a median of 26 years after the operation. RESULTS: Patients were divided into two groups: Group I (172 patients) underwent cholecystectomy only and Group II (122 patients) underwent cholecystectomy and common duct stone extraction. During the follow-up, 25 patients (9%) underwent examinations for biliary colics and 12 (4%) were re-operated, 10 during 1-5 years after cholecystectomy. Both the examinations and re-operations were more common in Group II than in Group I (p < 0.005). Eight patients developed alimentary tract cancer during the follow-up. Thirty-nine per cent of patients reported abdominal symptoms, 20% having had these already prior to cholecystectomy. Abdominal pain was reported by 21%, distention by 20%, heart burn 16%, obstipation 14%, and diarrhea by 11%. Abdominal pain and diarrhea occurred more frequently in Group I than in Group II. CONCLUSION: Recurrent biliary colics and stones in the common bile duct are extremely rare later than five years after cholecystectomy and are not expected unless the patients have also initially had common duct stones. One third of patients suffer from other abdominal symptoms.

Case-Control Studies↗

PubMed1996

The impact of laparoscopic cholecystectomy on the practice and training of gallbladder surgery in Thailand.

The objective of this study was to find out the impact laparoscopic cholecystectomy had on the practice and training of cholecystectomy in Thailand. This study involved prospective interviewing by questionnaires, of patients who had had cholecystectomies by laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) techniques starting from their immediate postoperative days, comparison of the length of hospital stay and the costs of LC and OC, and the surveillance of Thai laparoscopic surgeons' experience and surgical residents' attitude towards this procedure. The results revealed that laparoscopic surgeons offered LC to most of their patients with gallstones but in each institution the proportion of cholecystectomies performed was below 70%. Patients' satisfaction was higher and postoperative pain was less after LC. Complications occurred in 2.12% (37 in 1744 patients). The length of hospital stay was slightly shorter (2.68 +/- 0.62 versus 3.30 +/- 0.95 days) and the expenses were only slightly higher for LC. Most residents were interested to learn this procedure only after they have finished their formal surgical training; they still felt that LC was suitable only for patients with a higher economic status and that it was associated with a higher complication rate. This study suggest that LC did have an impact on the practice of cholecystectomy and future planning of trainings should take into account the necessity to change residents' misunderstanding about the suitability of this procedure in appropriate patients.

Adult↗

PubMed1996

Management of bile duct stones in the era of laparoscopic cholecystectomy: appraisal of routine operative cholangiography and endoscopic treatment.

OBJECTIVE: To assess the value of preoperative or postoperative endoscopic treatment of bile duct stones and routine use of operative cholangiography (OC) for detection of unsuspected common bile duct (CBD) stones in conjunction with laparoscopic cholecystectomy. DESIGN: Prospective study. SETTING: University hospital, Sweden. MAIN OUTCOME MEASURES: Diagnostic and therapeutic yield of stones at endoscopic retrograde cholangiography (ERC) before or after laparoscopic cholecystectomy and routine operative cholangiography. RESULTS: Of 630 patients who underwent laparoscopic cholecystectomy, 84 had preoperative ERC. Of these 84, 47 (56%) had bile duct stones. Endoscopic sphincterotomy was done for all 47, of whom 3 (6%) had retained stones at OC. OC was done for 590 (94%) of the 630 patients, and 45 (7.6%) were found to have choledocholithiasis. At postoperative ERC, however, 10 of these patients were free of stones and there were two cases of false negative OC, which resulted in sensitivity and specificity of OC of 95% and 98%, respectively. Thus, 35 patients (6%) had bile duct stones discovered at OC, of whom 33 had "unsuspected" stones. Of these 35 patients, 29 were cleared endoscopically after cholecystectomy. The remaining 6 patients were cleared of stones either by open choledocholithotomy (n = 2) or by laparoscopic transcystic manipulation (n = 4). There was no mortality after diagnostic or therapeutic ERC, and morbidity was confined to two cases each of pancreatitis and cholangitis, which resulted in a complication rate of 3% (4/118). No complications resulted from IOC. CONCLUSIONS: Preoperative ERC should be done for patients with symptoms or findings indicating ductal calculi. In most patients undergoing laparoscopic cholecystectomy, OC is feasible and its routine use is strongly advocated. Bile duct stones diagnosed at OC can safely and successfully be treated endoscopically after laparoscopic cholecystectomy. Until laparoscopic bile duct exploration becomes routine and generally applicable, endoscopic management of bile duct stones both before and after cholecystectomy will be an important therapeutic option.

Cholangiography↗